Hereditary and Acquired Ichthyosis Vulgaris Workup_ Procedures, Histologic Findings

6/17/2015 HereditaryandAcquiredIchthyosisVulgarisWorkup:Procedures,HistologicFindings

http://emedicine.medscape.com/article/1112753workup#showall 1/3

HereditaryandAcquiredIchthyosisVulgarisWorkupAuthor:RobertASchwartz,MD,MPHChiefEditor:DirkMElston,MDmore...

Updated:May28,2015

ProceduresSkinbiopsyspecimenscanbeexaminedunderlightmicroscopyandelectronmicroscopy.Takebiopsysamplesfromregionsofmaximalhyperkeratosisbecauseareasofmildscalingarelessreliableforhistopathologicanalysisandfindingsmaybeindistinguishablefromthoseofnormalskin.Thethickestscalesareusuallyfoundontheanterioraspectofthelowerleg.

HistologicFindingsThehistologicalappearanceofbothhereditaryichthyosisandacquiredichthyosisispracticallyidentical.Thestratumcorneumshowscompacthyperkeratosis,althoughsomeareascanbelaminated.Follicularpluggingmaybepresentandrepresentsassociatedkeratosispilaris.Thegranularlayerisusuallyonelayerthickorabsent.Ichthyosiformsarcoid,amanifestationofacquiredichthyosisinsarcoidpatients,hastheadditionalpresenceofmultiplenoncaseatinggranulomasinthedermis.Notetheimagebelow.

Hematoxylinandeosinstainingofacquiredichthyosisvulgarisinanadult.Showsepidermalatrophyw iththinningofthegranularlayer.Nodermalinfiltrateisevident.

Ultrastructuralstudiesshowreducedorabsentkeratohyalingranuleshousedinthegranularlayer.Theyappearspongyorcrumbly,mostlikelyduetodefectivekeratohyalinsynthesis.Thehyperkeratoticportionsofthestratumcorneumhaveanormalkeratinpattern.

ContributorInformationandDisclosuresAuthorRobertASchwartz,MD,MPHProfessorandHeadofDermatology,ProfessorofPathology,Pediatrics,Medicine,andPreventiveMedicineandCommunityHealth,RutgersNewJerseyMedicalSchoolVisitingProfessor,RutgersUniversitySchoolofPublicAffairsandAdministration

RobertASchwartz,MD,MPHisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,NewYorkAcademyofMedicine,AmericanAcademyofDermatology,AmericanCollegeofPhysicians,SigmaXi

Disclosure:Nothingtodisclose.

Coauthor(s)JasonFOkulicz,MD,FACP,FIDSADirector,HIVMedicalEvaluationUnit,InfectiousDiseaseService,SanAntonioMilitaryMedicalCenterAssociateProfessorofMedicine,FEdwardHebertSchoolofMedicine,UniformedServicesUniversityoftheHealthSciencesClinicalAssociateProfessorofMedicine,UniversityofTexasHealthScienceCenteratSanAntonioAdjunctClinicalInstructor,FeikSchoolofPharmacy,UniversityoftheIncarnateWord

JasonFOkulicz,MD,FACP,FIDSAisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanCollegeofPhysiciansAmericanSocietyofInternalMedicine,InfectiousDiseasesSocietyofAmerica


SpecialtyEditorBoardDavidFButler,MDSectionChiefofDermatology,CentralTexasVeteransHealthcareSystemProfessorofDermatology,TexasA&MUniversityCollegeofMedicineFoundingChair,DepartmentofDermatology,ScottandWhiteClinic

DavidFButler,MDisamemberofthefollowingmedicalsocieties:AmericanMedicalAssociation,AlphaOmegaAlpha,AssociationofMilitaryDermatologists,AmericanAcademyofDermatology,AmericanSocietyforDermatologicSurgery,AmericanSocietyforMOHSSurgery,PhiBetaKappa


LesterFLibow,MDDermatopathologist,SouthTexasDermatopathologyLaboratory

LesterFLibow,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,AmericanSocietyofDermatopathology,TexasMedicalAssociation




ChiefEditorDirkMElston,MDDirector,AckermanAcademyofDermatopathology,NewYork

DirkMElston,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology


AdditionalContributorsAlbertCYan,MDSectionChief,AssociateProfessor,DepartmentofPediatrics,SectionofDermatology,Children'sHospitalofPhiladelphiaandUniversityofPennsylvaniaSchoolofMedicine

AlbertCYan,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,SocietyforInvestigativeDermatology,SocietyforPediatricDermatology,AmericanAcademyofPediatrics


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Hereditary and Acquired Ichthyosis Vulgaris Workup_ Procedures, Histologic Findings

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